1442:'NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC. WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
another like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
4 tywv..
Subdivision Improvement Permit Class III
DATE:Y 19, 1992 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Paver. 11'6" wide. Haul Route:• Washington & 52 North
84,000 lbs, all else legal out of City Limits
DIMENSION OF INSTALLATION OR REMOVAL Haul Date: 5/19/92
SIZE OF EXCAVATION, IF NEEDED '
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of a[ ['obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, -defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from- claims or court action and arising out of any accident, loss or damage to person's or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative, at least twenty-four (24) hours in advance of the time when work will be started.
'Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
Signature of A II ant or Agent
.Tarmac California, Inc. P.O. Box 14050 Palm Desert, CA 92255 775-8267
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
On File On File
Contractor's License No. City Business License No.
On File On File
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class I I I
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee $
Permit Fee 10.00.
Penalty
Cash Deposit -Surety Bond
if required
TOTAL: $ 10.00
Receipt No.
Received by Date
1442.
PERMIT VALIDATION
PERMIT NO. 1442
DATE APPROVED 5/19/9.2
EXPIRATION DATE 5/19/92.
DATE ISSUED 5/19/92
By
Administrative Authority
Recorded by II : TELEPHONE: (619) 564-2246
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CITY OF LA CUJNTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSMUCTION (ENCROAC-MMENT)
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